Summary & Overview
CPT 67902: Frontalis Sling Repair of Eyelid Ptosis with Graft
CPT code 67902 represents a surgical repair for eyelid ptosis in which the upper eyelid is attached to the frontalis muscle using a tissue graft. This procedure addresses functional vision obstruction or cosmetic deformity and is performed by oculoplastic or ophthalmic surgeons. Nationally, 67902 is relevant for surgical ophthalmology billing and utilization, impacting outpatient surgical volumes, coverage determinations, and prior authorization protocols.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical indications, typical sites of service (outpatient surgical suites and ambulatory surgery centers), and payer coverage patterns where available. Readers will find benchmarks on utilization and reimbursement (where reported by payers), summaries of payer policy trends affecting coverage and prior authorization, and clinical context for coding and documentation that supports medical necessity.
This summary is intended for national audiences including providers, billing professionals, and policy analysts seeking a clear briefing on the clinical purpose of CPT code 67902, payer considerations, and the types of information to review when preparing claims for eyelid ptosis repair with a graft.
Billing Code Overview
CPT code 67902 describes a surgical procedure to repair a drooping eyelid (ptosis) by attaching the eyelid to the frontalis muscle in the forehead using a tissue graft from elsewhere on the patient’s body. The procedure may be performed to improve cosmetic appearance or to remove an obstruction to the patient’s vision.
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Service type: Surgical repair of eyelid (frontalis sling with graft)
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Typical site of service: Outpatient surgical suite or ambulatory surgery center; may also be performed in an inpatient setting when clinical circumstances require
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents with progressive unilateral upper eyelid droop that obstructs the superior visual field and causes functional impairment with reading and driving. Conservative measures, including topical lubricants and observation, failed to improve symptoms. Examination documents severe bilateral levator dehiscence with poor levator function on the affected side. The oculoplastic surgeon discusses surgical options and proceeds with a frontalis suspension using an autologous fascia lata graft harvested from the lateral thigh to connect the eyelid to the frontalis muscle, improving eyelid elevation and visual field. The procedure is performed in an ambulatory surgery center under monitored anesthesia care. Perioperative documentation includes preoperative consent, operative note describing graft harvest and tarsal fixation, intraoperative findings, and a postoperative plan with return precautions and a follow-up visit to assess eyelid position and graft function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s professional portion of a split billable service (rare for this surgical code). |
50 | Bilateral procedure |